在三个医疗系统中验证基于 ICD 代码的精神病病例定义。

IF 5.3 1区 医学 Q1 PSYCHIATRY
Anthony J Deo, Victor M Castro, Ashley Baker, Devon Carroll, Joseph Gonzalez-Heydrich, David C Henderson, Daphne J Holt, Kimberly Hook, Rakesh Karmacharya, Joshua L Roffman, Emily M Madsen, Eugene Song, William G Adams, Luisa Camacho, Sarah Gasman, Jada S Gibbs, Rebecca G Fortgang, Chris J Kennedy, Galina Lozinski, Daisy C Perez, Marina Wilson, Ben Y Reis, Jordan W Smoller
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引用次数: 0

摘要

背景与假设:精神病相关诊断代码越来越多地被用作基于电子健康记录(EHR)算法的病例定义,以预测和检测精神病。然而,有关精神病相关诊断代码有效性的数据却很有限。我们评估了国际疾病分类(ICD)代码对精神病的阳性预测值(PPV):研究设计:利用 3 个医疗系统的电子病历,将包含原发性精神病和伴有精神病的情绪障碍的 ICD 代码分为 5 个高阶组。使用完整的电子病历对 1133 份记录进行了抽样病历审查。计算了多种治疗环境下的 PPVs(根据 ICD 精神病代码,病历确认为精神病的概率):所有诊断组和医院系统的 PPV 均超过 70%:麻省综合医院 0.72 [95% CI 0.68-0.77],波士顿儿童医院 0.80 [0.75-0.84],波士顿医疗中心 0.83 [0.79-0.86]。精神分裂症的 PPV 值在各研究机构中一直最高(0.80-0.92),而重度抑郁伴精神病的 PPV 值变化最大(0.57-0.79)。为了确定首次记录的代码是否捕获了首发精神病(FEP),我们排除了之前病历中有精神病诊断或治疗证据的病例,结果 PPV 值大大降低(0.08-0.62):我们发现,首次记录的精神病诊断代码能准确捕捉到真正的精神病发作,但却不能很好地反映 FEP。这些数据对于用于开发风险预测模型以预测或检测未确诊精神病的病例定义具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validation of an ICD-Code-Based Case Definition for Psychotic Illness Across Three Health Systems.

Background and hypothesis: Psychosis-associated diagnostic codes are increasingly being utilized as case definitions for electronic health record (EHR)-based algorithms to predict and detect psychosis. However, data on the validity of psychosis-related diagnostic codes is limited. We evaluated the positive predictive value (PPV) of International Classification of Diseases (ICD) codes for psychosis.

Study design: Using EHRs at 3 health systems, ICD codes comprising primary psychotic disorders and mood disorders with psychosis were grouped into 5 higher-order groups. 1133 records were sampled for chart review using the full EHR. PPVs (the probability of chart-confirmed psychosis given ICD psychosis codes) were calculated across multiple treatment settings.

Study results: PPVs across all diagnostic groups and hospital systems exceeded 70%: Mass General Brigham 0.72 [95% CI 0.68-0.77], Boston Children's Hospital 0.80 [0.75-0.84], and Boston Medical Center 0.83 [0.79-0.86]. Schizoaffective disorder PPVs were consistently the highest across sites (0.80-0.92) and major depressive disorder with psychosis were the most variable (0.57-0.79). To determine if the first documented code captured first-episode psychosis (FEP), we excluded cases with prior chart evidence of a diagnosis of or treatment for a psychotic illness, yielding substantially lower PPVs (0.08-0.62).

Conclusions: We found that the first documented psychosis diagnostic code accurately captured true episodes of psychosis but was a poor index of FEP. These data have important implications for the case definitions used in the development of risk prediction models designed to predict or detect undiagnosed psychosis.

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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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